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Bone Cancer
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What Is Bone Cancer?
Primary bone cancer, also known as bone sarcoma, is a tumor that develops from the cells forming the bone. In general, sarcomas are tumors that start from the connective tissue, which is the tissue that connects, supports, and surrounds other body structures. This includes bone, muscle, fat, blood vessels, nerves, tendons, and the lining of the joints.
Bone cancer most commonly starts in the long bones of legs and arms, in the knee area and in the pelvis, but it can arise from any bone. The most common types of bone cancers are osteosarcoma, Ewing sarcoma, chondrosarcoma and chordoma. Osteosarcoma and Ewing sarcoma are especially frequent in children and teenagers, while chondrosarcoma and chordoma are mostly seen in adult patients. However, all bone sarcomas can occur at any age. Other types of sarcoma such as leiomyosarcoma, angiosarcoma, pleomorphic sarcoma, giant cell tumor of bone and other can also rarely arise in the bone. Some types of blood cancers start in the blood-forming cells of the bone marrow but not the bone itself. Those cancers are not discussed on this page and do not classify as bone cancer.
Secondary bone cancer is a cancer that affects the bone but has originated from a different site than the bone. Many other cancers can spread (metastasize) to the bone, when that occurs, they are not classified as bone cancer but are named for where they began, such as lung cancer that has metastasized to the bone. Those cancers are not covered on this page.
According to the American Cancer Society, there are approximately 3,900 new cases and 2,100 deaths from bone cancer each year.
Why Come to CU Cancer Center for Bone Cancer
As the only National Cancer Institute Designated Comprehensive Cancer Center in Colorado and one of only four in the Rocky Mountain region, the University of Colorado Cancer Center has doctors who provide cutting-edge, patient-centered bone cancer care and researchers focused on diagnostic and treatment innovations.
The CU Cancer Center has a multidisciplinary program for sarcomas, including bone cancer. This is a great option for patients who are recently diagnosed, looking for a second opinion, or already in treatment. Our team will gather a group of surgical oncologists, medical oncologists, radiation oncologists, pathologists, dietitians, genetic counselors, and more to make sure each patient is getting the best care that is unique to his/her diagnosis.
There are numerous clinical trials being conducted by CU Cancer Center members at any time, including trials that enroll bone sarcomas. These trials offer patients other options besides traditional bone cancer treatment. Your oncologist will be able to identify potential trials for which bone cancer is eligible.
Bone Cancer Prognosis and Survival Rates
Bone cancer prognosis depends on the type of cancer and the stage at which it is diagnosed. Bone cancers account for less than 0.2% of all cancers in the United States.
The five-year survival rate for bone cancer — the percentage of people who live at least five years after the disease is found —varies by the specific type of cancer. It ranges from 67% for osteosarcoma to 82% for chordoma.
Our clinical partnership with UCHealth has produced survival rates higher than the state average for all stages of bone and joint cancers.
Number of Patients Diagnosed – UCHealth – 48 – State of Colorado – 197
Number of Patients Surviving – UCHealth – 33
– State of Colorado – 121
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)
Types of Bone Cancer
Bone cancers in children and teenagers include osteosarcoma and Ewing sarcoma. Common types of bone cancer in adults are chondrosarcoma, giant cell tumor, and chordoma.
Osteosarcoma is the most common type of bone cancer. It usually affects children and teenagers, but it can develop in any age group. Osteosarcoma typically starts in parts of the body where bones grow quickly — including leg bones, around the knee, arm bones, around the shoulder — but it can develop anywhere, including the pelvis, the skull, and jaw.
→ Disney+ Movie Raising Awareness of Osteosarcoma
Ewing sarcoma, also known as Ewing tumors, is most common in teenagers and older children. It most commonly develops in the chest wall (shoulder blades or ribs), pelvis, and long bones of the leg.
Chondrosarcoma is the second most common bone cancer in adults after the age of 40, although it can present at any age. Chondrosarcoma develops from cartilage cells that are found between bones and joints in the legs, arms or pelvis. It also can start in the shoulder blade, ribs, and skull, and even in the trachea, larynx, or chest wall.
Chordoma is most often found in adults 30 and older and is twice as common in men as in women. The tumors usually develop at the base of the skull and in the bones of the spine.
Giant cell tumors most frequently occur in young and middle-aged adults. They usually develop in the legs and arms.
Bone Cancer in Dogs
More than 10,000 dogs are diagnosed with osteosarcoma each year. This cancer, while rarer in humans, is nearly identical and the treatment options are similar. More than 30 years ago, veterinarians at CU Cancer Center partner Flint Animal Cancer Center (FACC) at Colorado State University in Fort Collins helped develop a limb spare surgery technique for dogs that informed the same procedure in kids. Today, the FACC
team continues to search for better therapies to treat primary bone cancer and tumor metastasis, which spreads to the lungs in approximately 80 percent of canine patients. A combination drug therapy developed at FACC for dogs with metastatic bone
cancer is now in stage 2 clinical trials for humans at Children’s Hospital Colorado and Atlanta Children’s Hospital.
Risk Factors for Bone Cancer
Bone cancer has multiple risk factors: behaviors or conditions that increase a person’s chances of getting a disease such as cancer. Risk factors for bone cancer include:
- Genetic disorders including multiple exostoses syndrome, multiple osteochondromas syndrome, multiple enchondromatosis, tuberous sclerosis, and Paget disease.
- Exposure to large doses of radiation.
- Exposure to radioactive materials.
- Bone marrow transplantation.
Symptoms of Bone Cancer
Bone cancers can usually be treated successfully if they are diagnosed before the cancer has spread to other parts of the body. Patients with early-stage bone cancer may not experience symptoms, but those with later stages of the disease may.
Symptoms of bone cancer include:
- Bone or joint pain.
- Swelling near a bone.
- Sudden bone fractures or breaks for no apparent reason.
- Numbness, tingling, or weakness in the body.
- Fatigue.
- Weight loss.
Screening for Bone Cancer
Screening is used to look for cancer before a person shows any symptoms of the disease. There are no standard screenings for bone cancer, but if a patient has symptoms, doctors can perform tests that detect the presence of tumors.
Diagnosing Bone Cancer
Based on a patient’s symptoms and after an initial physical examination, a doctor may order certain tests to determine whether the patient has a bone cancer. Though testing procedures can vary based on the type of bone cancer the doctor is looking for, common screenings for bone cancer include:
X-rays: Most bone cancers are detectable by X-ray, making them easier for doctors to find. Doctors will often perform a chest X-ray as well, to see if bone cancer has spread to the lungs.
Radionuclide bone scans: These “nuclear medicine scans” look to see if cancer has spread to other bones. They can find smaller areas of metastasis (spread) better than a regular X-ray can. They also reveal the amount of damage the cancer has caused in the bones.
Magnetic resonance imaging (MRI): An MRI uses radio waves and magnetic fields to produce detailed images of the body. In some situations, the doctor may order an MRI scan of the bone to get a more detailed picture.
Computed tomography (CT or CAT) scan: A CT scan uses X-rays to take detailed images of the body and can help identify several types of tumors. A CT scan can provide detailed information about the size, shape, and location of tumors in the bone and see if a tumor is growing into nearby tissues, lymph nodes, or organs.
Positron emission tomography (PET) scan: In this test, a slightly radioactive form of sugar is injected into the blood, where it is taken in by cells in the body. Since cancer cells grow faster than normal cells, they take in larger amounts of the sugar. Doctors use PET scans to look for possible areas of cancer spread and to determine if suspicious areas seen in other imaging tests are cancer or not.
Biopsy: During a biopsy, a doctor extracts a sample (or multiple samples) of tissue from the suspected tumor site. These are sent to a laboratory for analysis by a pathologist to determine whether the cells in the sample are cancerous. There are different kinds of biopsies, and the type of biopsy a patient receives is determined by several factors, including the size and location of the tumor, the number of tumors, and the type of cancer suspected.
Stages of Bone Cancer
After diagnosing the presence of bone cancer, the doctor will identify the stage of the disease. The stage is determined by several factors, including where exactly the disease formed, how extensive it is, and whether and how much it has spread.
Many of the same tests used to diagnose bone cancer are also used to identify the stage, including X-rays, CT/CAT scans, MRI scans, and PET scans.
Doctors typically use the American Joint Committee on Cancer’s TNM system to determine the stage of bone cancer. The TNM system assesses the size and extent of the tumor (T) and whether it has spread; the involvement of nearby lymph nodes (N); and the presence and extent of metastasis (M) to other areas of the body, including the lungs, liver, and bones.
Bone Cancer Stages
After the TNM assessment, the doctor will assign an overall stage number from I to IV. These can be broken down further based on the size of the original tumor and the extent to which the cancer has spread. In general, the lower the stage the better the prognosis and treatment options.
Bone cancers also are graded (G) based on how abnormal their cells look when viewed under a microscope. Bone cancers are graded from 1 to 3. G1 cancers typically spread more slowly than G2 or G3 cancers.
Stage IA: The cancer measures eight centimeters across or less. It has not spread to nearby lymph nodes or distant sites. The cancer is graded G1 or the grade can’t be determined.
Stage IB: The cancer measures more than eight centimeters across and has not spread to nearby lymph nodes or to distant sites; OR the cancer is seen in more than one place on the same bone and has not spread to nearby lymph nodes or distant sites. In either case, the cancer is graded G1 or the grade can’t be determined.
Stage IIA: The cancer measures eight centimeters or less and has not spread to nearby lymph nodes or distant sites. The cancer is graded G2 or G3.
Stage IIB: The cancer is more than eight centimeters and has not spread to nearby lymph nodes or distant sites. The cancer is graded G2 or G3.
Stage III: The cancer is seen in more than one place on the same bone and has not spread to nearby lymph nodes or distant sites. The cancer is graded G2 or G3.
Stage IVA: The cancer can be any size and may be in more than one place on the same bone. It has spread to the lungs, but not to nearby lymph nodes or other areas of the body. The cancer can be any grade.
Stage IVB: The cancer can be any size, may be in more than one place on the same bone, and has spread to nearby lymph nodes. It may or may not have spread to other bones or distant organs such as the lungs; OR the cancer can be any size, may be in more than one place on the same bone, and has spread to other bones or distant sites such the liver or brain. It may or may not have spread to nearby lymph nodes. In either case, the cancer can be any grade.
Treatments for Bone Cancer
The treatment for bone cancer is customized to each patient and depends on the size and location of the tumor(s), the stage at which the patient is diagnosed, and the patient’s general health. Bone cancer care teams may include multiple health care specialists, including primary care providers, medical oncologists, orthopedic oncologists, radiation oncologists, and orthopedic surgeons, as well as nurse practitioners, physician assistants, nurses, psychologists, social workers, and rehabilitation specialists. CU Cancer Center doctors offer specialized care for patients with bone cancer.
Treatments for bone cancer include surgery, radiation therapy, chemotherapy, and targeted drug therapy. Patients may receive one or more of these treatments in combination. Some patients may also be eligible to participate in clinical trials — doctor-led research studies of new or experimental procedures or treatments.
Surgery for Bone Cancer
Surgery is the primary treatment for bone cancer. The primary goal is to remove all of the cancer. To make sure that no cancer cells are left that might grow and make a new tumor, doctors use a process called wide-excision, which removes the tumor as well as some of the normal tissue around it. In rare cases, an amputation is performed to remove all of the cancer from an arm or leg, but most of the time doctors try to use limb-sparing surgery that leaves working limbs.
Radiation Therapy for Bone Cancer
Radiation therapy uses high-powered energy to kill cancer cells. A doctor who specializes in radiation therapy to treat cancer is a radiation oncologist. The main type of radiation therapy used to treat bone cancer is external beam radiation.
External-beam radiation therapy (EBRT) is the most common radiation treatment and uses a machine located outside the body to focus a beam of X-rays on the area with the cancer. The two most common types of EBRT for bone cancer are intensity-modulated radiation therapy (IMRT) and proton therapy.
Chemotherapy for Bone Cancer
Chemotherapy uses drugs to kill rapidly growing cancer cells. Drugs are either injected into a vein or taken orally. Chemotherapy is often used for Ewing sarcoma and osteosarcoma but not for other bone cancers such as chordomas, chondrosarcomas, and giant cell tumors. Chemotherapy drugs used in the treatment of bone cancer include Doxorubicin, Cisplatin, Etoposide, Ifosfamide, Cyclophosphamide, Methotrexate, and Vincristine. In many cases, two or three drugs are taken at the same time.
Targeted Drug Therapy for Bone Cancer
Targeted therapy focuses on the specific genes, proteins, or tissue environments that contribute to bone cancer, limiting damage to non-cancerous cells and tissues.
The most common targeted drug therapies for bone cancer include:
Imatinib: Gene defects in some chordomas create proteins that signal cancer cells to grow. Imatinib (Gleevec) can block signals to those defective genes, causing cancers to stop growing or even shrink.
Denosumab: A protein called RANK ligand instructs cells called osteoclasts to break down bone. When Denosumab (Xgeva or Prolia) binds to RANK ligand, it blocks that instruction, which can help shrink tumors temporarily.
The University of Colorado (CU) Cancer Center partners with UCHealth, Children’s Hospital Colorado, and Rocky Mountain Regional VA to provide clinical care. Please make an appointment with one of our clinical partners to be seen by a CU Cancer Center doctor.
UCHealth Cancer Care - Anschutz Medical Campus
1665 Aurora Court Anschutz Cancer Pavilion
Aurora, CO 80045
720-848-0300
Children's Hospital Colorado:
13123 East 16th Avenue
Aurora, CO 80045
720-777-6740
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Information reviewed by Breelyn Wilkey, MD, in August 2022.